Westborough, MA April 5, 2015 The spring try-out has all but been completed. Most varsity teams have their rosters set and the games have begun. In terms of collision sports men’s lacrosse and women’s softball both have high incidence of concussion. As seasons have gone by, I have seen an elevated rate of girls being injured during softball while sliding into their base or from player on player collisions. Arguably, fast pitch softball has a high incidence of batters being hit by pitch resulting in concussion. Men’s baseball also has a high incidence of concussion from wild pitches hitting batter helmets to outfield collisions.
Every spring I mail out reminder cards to the schools I take care of reminding athletic director’s to have their athlete’s sign on and take the pre-season baseline test – if they have not done so in the fall. Most of the time I try and encourage trainers to refer cases of concussion for neuropsychological assessment early rather than later when symptoms have become chronic. Early referral to a trained neuropsychologist can have a positive impact on successful return to play – including providing support for a step-by-step return to play plan. I have said over and over that no player should go from zero play to game play without first going through a supervised return to play protocol. No matter what you might think, the return to play protocol is the safest way to introduce an athlete back to sport and offers the least likely chance of an athlete being diagnosed with post-concussion syndrome – a chronic set of symptoms that can include headaches, poor attention, decreased short-term memory, depression, and more. Yet I am still seeing physician’s who release student athletes for “game” play with only 5-7 days of rest. Many believe this is inadequate.
Here in Massachusetts the MIAA has required that athletes be cleared by their primary physician before they are eligible to return to play. Since the inception of the MIAA requirements the MIAA has broadened the definition of clinician that may clear an athlete for play to include clinical neuropsychologists and nurse practitioners with documented training in concussion management. I am finding that some schools have allowed athletes to return to play prior to being officially cleared by their doctors – sometimes by the team trainer with some training in concussion. This falls outside of the letter of the law set forth in the MIAA mandate and places athletes at risk.
It is prudent to have student athletes see a primary care physician and or another practitioner who can set forth a comprehensive return to play plan that allows for 7-10 days of rest followed by an active plan to return the athlete to the field of play as soon as safely possible. Early referral to a specialist may be warranted whenever recovery takes an unexpected turn.